内镜逆行胰胆管造影联合eyeMax胆胰成像系统直视下液电碎石治疗困难胆管结石效果观察

陶丽莹; 王宏光; 郭庆梅; 朴连玉; 郭享; 阮丽斌; 刘时助; 孙震

doi:10.12449/JCH240220

内镜逆行胰胆管造影联合eyeMax胆胰成像系统直视下液电碎石治疗困难胆管结石效果观察

DOI: 10.12449/JCH240220

吉林市人民医院消化内科，吉林吉林 132001

基金项目:

吉林省卫生健康科技能力提升项目 (2022LC143)

伦理学声明：本研究方案经由吉林市人民医院伦理委员会审批，批号：LS-2023-0004，所纳入患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：陶丽莹负责课题设计，收集数据，资料分析，撰写论文；王宏光、郭庆梅、刘时助负责手术的相关操作；朴连玉负责术中麻醉；郭享、阮丽斌、孙震负责围手术期及术后管理。

详细信息

通信作者:
王宏光， wanghongguang1817@163.com （ORCID： 0000-0003-1100-9804）

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出版历程
- 收稿日期: 2023-05-19
- 录用日期: 2023-06-20
- 出版日期: 2024-02-19

Efficacy of endoscopic retrograde cholangiopancreatography combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in treatment of difficult choledocholithiasis

Department of Gastroenterology，Jilin People’s Hospital，Jilin，Jilin 132001，China

Research funding:

Jilin Province Health Science and Technology Capacity Improvement Project (2022LC143)

More Information

Corresponding author: WANG Hongguang， wanghongguang1817@163.com （ORCID： 0000-0003-1100-9804）

摘要

摘要: 目的探讨内镜逆行胰胆管造影（ERCP）联合eyeMax胆胰成像系统直视下应用液电碎石技术治疗困难胆管结石的安全性及有效性。方法回顾性分析2022年5月—11月吉林市人民医院消化内科行ERCP联合eyeMax胆胰成像系统直视下应用液电碎石技术治疗困难胆管结石12例患者的临床资料，观察碎石、取石的临床效果，评估术后并发症发生情况，以及手术操作时间。结果 12例患者中，11例（91.67%）患者直视液电碎石成功，9例（75.00%）一次性取石成功，11例（91.67%）达到结石完全清除，1例患者因多次胆道手术造成胆管多处狭窄，直视下将狭窄处上方的Ⅱ级肝内胆管结石取出，但仍残留Ⅲ级肝内胆管结石，进而未能达到结石完全清除的效果；ERCP平均操作时间（91.3±26.2）min，其中能量碎石时间为（41.8±22.2）min；术后2例胆道感染，给予抗感染后好转；2例高淀粉酶血症，未予特殊处置；3例轻度胰腺炎，给予药物对症治疗后好转；无出血、穿孔等并发症。结论 ERCP联合eyeMax胆胰成像系统直视下应用液电碎石技术治疗困难胆管结石安全、有效、可行。
- 胆总管结石病 /
- 胰胆管造影术，内窥镜逆行 /
- eyeMax胆胰成像系统 /
- 碎石术
Abstract: Objective To investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography （ERCP） combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in the treatment of difficult choledocholithiasis. Methods A retrospective analysis was performed for the clinical data of 12 patients with difficult choledocholithiasis who underwent ERCP and electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in Department of Gastroenterology， Jilin People’s Hospital， from May to November 2022. The clinical effect of lithotripsy and lithotomy was observed， and postoperative complications and time of surgical operation were assessed. Results Among the 12 patients， 11 （91.67%） were successfully treated by electrohydraulic lithotripsy under direct view， 9 （75.00%） achieved first-attempt success in lithotripsy， and 11 （91.67%） had complete removal of calculi； 1 patient was found to have stenosis of the bile ducts caused by multiple biliary tract surgeries， and grade Ⅱ intrahepatic bile duct stones above the sites of stenosis were removed under direct view， but there were still residues of grade Ⅲ intrahepatic bile duct stones， which led to the fact that complete calculus removal was not achieved. The mean time of ERCP operation was 91.3±26.2 minutes， including a time of 41.8±22.2 minutes for energy lithotripsy. There were 2 cases of postoperative biliary tract infection which were improved after anti-infective therapy， 2 cases of hyperamylasemia which were not given special treatment， and 3 cases of mild pancreatitis which were improved after symptomatic medication， and there were no complications such as bleeding and perforation. Conclusion ERCP combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system is safe， effective， and feasible in the treatment of difficult choledocholithiasis.
- Choledocholithiasis /
- Cholangiopancreatography， Endoscopic Retrograde /
- eyeMax Bilio-Pancreatic Imaging System /
- Lithotripsy

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图 1 ERCP联合eyeMax胆胰成像系统及液电操作流程

注： a，MRCP提示胆总管巨大结石；b，eyeMax胆胰成像系统观察胆总管内巨大结石，可观察到结石的纹理；c，eyeMax胆胰成像系统直视下液电碎石；d，eyeMax胆胰成像系统观察液电碎石取石后的胆管，可见少量泥沙结石附着胆管壁；e，困难胆管结石碎石、取石后留置鼻胆管，造影观察胆管无结石残留；f，eyeMax胆胰成像系统直视进入Ⅱ级肝内胆管，远观Ⅲ级肝内胆管可见瘢痕狭窄；g，eyeMax胆胰成像系统直视下应用子母网篮进行Ⅲ级肝内胆管结石取石；h，eyeMax胆胰成像系统直视下取出少量泥沙样结石。

Figure 1. ERCP combined with eyeMax bilio-pancreatic imaging system and hydroelectric lithotripsy process

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表 1 ERCP联合eyeMax胆胰成像系统直视液电碎石治疗困难胆管结石病例资料

Table 1. The data of ERCP combined with eyeMax bilio-pancreatic imaging system for direct vision hydroelectric lithotripsy in the treatment of difficult bile duct stones

患者	年龄	性别	诊断	结石最大直径（mm）	结石数量（枚）	结石位置	既往手术史	ERCP取石史	取石次数	ERCP操作时间（min）	液电碎石操作时间（min）	结石是否完全清除	不良并发症
1	61	男	胆总管结石，右肝管结石伴嵌顿	28	5	胆总管、右肝管	无	无	1	90	45	是	高淀粉酶血症
2	35	男	肝门部胆管，左、右肝内胆管结石伴嵌顿	15	4	肝门部胆管，左、右肝管	无	无	2	90	51	是	无
3	87	女	肝左叶肝内胆管结石伴嵌顿	17	6	左肝管	无	无	1	90	35	是	无
4	70	女	胆总管结石，壶腹部憩室	18	1	胆总管	无	无	1	65	40	是	无
5	84	男	胆总管结石，壶腹部憩室	20	1	胆总管	无	无	1	120	85	是	胆管炎
6	67	女	胆总管结石	25	1	胆总管	无	无	1	120	70	是	胆管炎
7	52	男	左肝内胆管结石，胆管狭窄	10	>10	左肝管	胆囊切除术，胆管切开取石术、T管引流术	有	2	90	15	否	无
8	57	女	胆总管结石	32	1	胆总管	无	无	2	120	65	是	胰腺炎
9	58	女	肝左叶肝内胆管结石伴嵌顿	8	3	左肝管	无	无	1	120	26	是	胰腺炎
10	52	女	胆囊管残端结石伴嵌顿	9	1	胆囊管残端	胆囊切除术	无	1	70	15	是	无
11	71	男	胆总管结石，肝左叶肝内胆管结石伴嵌顿	9	6	胆总管	无	无	1	90	42	是	胰腺炎
12	60	男	胆囊管残端结石伴嵌顿	8	1	胆囊管残端	胆囊切除术	无	1	30	12	是	高淀粉酶血症

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